After clicking ‘Buy Now’, just choose if this is for you or a gift for someone else. Then click ‘Next Step’ to continue.

from £2.50 per month

Individual Membership

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from £3 per month

Joint Membership For Two

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from £3.50 per month

Family Membership With Extras For Kids

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Subject:

Message:

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This is a gift

Gift Details

Please send the joining pack:

To me, the payer

Directly to the recipient(s)

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Gift Membership Details * indicates required field

Who is it for?

Primary member details

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Name:

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Alternate contact number:

Date of Birth:

Membership Address

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Address:

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Additional Members

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Joint Members

Member 2:

Member 3:

Member 4:

Child Members

Child 1:

Child 2:

Child 3:

Child 4:

Child 5:

Child 6:

Make your gift worth more for wildlife

Are you a UK taxpayer? Please tick the box below and for every £1 you give, we can claim a further 25p from HM Revenue and Customs, at no extra cost to you!

I am a UK taxpayer, and would like Derbyshire Wildlife Trust to reclaim the tax on this and any other eligible donations or membership subscriptions that I may make in the future or have made in the past 4 years. I understand that I need to pay enough Income Tax or Capital Gains Tax in each tax year to cover the Gift Aid claimed on all my donations otherwise it is my responsibility to pay any difference.

If in the future your circumstances change and you no longer pay income tax or capital gains for your donations to be eligible for Gift Aid, you can cancel this declaration by notifying us.

Gift Aid declaration:

Register me for Gift Aid with Derbyshire Wildlife Trust

I am NOT a UK tax payer

I do not wish to Gift Aid my donations

Contact Preferences

We'd love to contact you in the future to let you know how your support is helping local wildlife. We'd also like to let you know about local conservation work, events in your area and other ways you can get involved with local wildlife. Just let us know how you'd like us to contact you for now. You can easily change your contact preferences at any time and we will never pass your details to any third parties.

I am happy to be contacted by Derbyshire Wildlife Trust about conservation, membership, fundraising and other activities by:

post

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No

email

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telephone

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No

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Additional info/comments:

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Membership Type

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Who is it for?

Gift Details

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Membership Details

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Contact Preferences:

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Address:

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Additional Adult

Title:

First name:

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Relationship to primary member:

Title:

First name:

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Relationship to primary member:

Title:

First name:

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Relationship to primary member:

Additional Children

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First name:

Surname:

Date of Birth:

Title:

First name:

Surname:

Date of Birth:

Title:

First name:

Surname:

Date of Birth:

Title:

First name:

Surname:

Date of Birth:

Title:

First name:

Surname:

Date of Birth:

Title:

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Surname:

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Payment Options

Pay by Direct Debit

Pay by Credit Card

Monthly

Annually

The Direct Debit Guarantee

This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.

If there are any changes to the amount, date or frequency of your Direct Debits Derbyshire Wildlife Trust will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Derbyshire Wildlife Trust to collect a payment, confirmation of the amount and date will be given to you at the time of the request.

If an error is made in the payment of your Direct Debit, by Derbyshire Wildlife Trust or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society.

If you receive a refund you are not entitled to, you must pay it back when Derbyshire Wildlife Trust asks you to.

You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

Payment Contact Details

Title:

Name:

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Email:

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Alternate contact number:

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Address:

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Donation details

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Bank details

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Please send confirmation:

By email

By post and email

I am the account holder and the only person required to authorise debits on this account:

Notice: If you are not the account holder or more than one person is required to authorise debits on this account unfortunately we are unable to accept your direct debit instruction online. If this is the case then please call us on 01773 881188 for alternative payment methods

Confirm Details

Credit Card

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Confirm Direct Debit Details

Thank you for choosing to pay by Direct Debit. Payments will appear as Derbyshire WT and we will send confirmation of the Direct Debit setup by post/email within 3 working days or no later than 10 working days before the first collection.

Please pay Derbyshire Wildlife Trust Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with Derbyshire Wildlife Trust and, if so, details will be passed electronically to my Bank/Building Society

Date

25/05/2019

Banks and Building Societies may not accept Direct Debit Instructions for some types of account